Raising concern “about the direction the health care policy debate is moving” – particularly among conservative lawmakers – the National Center for Public Policy Research has joined with more than 70 other conservative and free-market organizations to warn Congress about the dangers of price fixing.
In trying to remedy the issue of surprise medical bills for out-of-network emergency treatment, and insurers balking at covering all of such costs, some typically conservative politicians are favoring proposals to essentially enact price controls on these health care services. This would prohibit doctors and hospitals from setting their own rates and potentially make them operate at a loss.
Senator Rand Paul has explained that this could compromise the quality of American health care by driving people out of the medical field. “If you fix the price that ER doctors work at,” he said, “you will get a shortage.” He suggested that what has happened to the economy in Venezuela could happen in the United States as a result of such changes to the marketplace.
In a letter to conservative lawmakers on Capitol Hill, the National Center and others note:
[W]hat is troubling is how often otherwise right-of-center policymakers are resorting to one of the key pillars of the Medicare for All playbook – government imposed price controls. Whether it is called price fixing, rate setting, subsidy capping or inflation capping, government price controls have wormed their way into the healthcare reform plans of too many of our friends in Washington.
The National Center is joined on the letter by organizations including Americans for Tax Reform, the Competitive Enterprise Institute, Frontiers of Freedom, the Discovery Institute, the Institute for Policy Innovation and Eagle Forum.
The coalition letter concludes:
This was a bad idea a half century ago with gasoline line rationing, and it’s a bad idea today in health care. Something can only be affordable if it’s available to buy in the first place.
To read the entire letter and see all of its signers, click here.
Hysteria over 'vaping-related lung illness' puts pressure on politicians, but vaping is safer than smoking
There are those who say vaping is a public health menace, that it’s designed to appeal to young people as a gateway to tobacco with no redeeming social values whatsoever. Others who say it’s a public health miracle that’s made it possible for tens of thousands of people addicted to cigarettes to quit and live healthier lives.
It’s not clear who’s right but the evidence thus far hews toward the idea that vaping, from the standpoint of public health, is largely beneficial. There have been a few deaths among young people but, as we’re now finding out, those can be attributed to carelessness, black market formulas based in oil rather than water, and the effort to get a quick high by employing a THC-like additive. They did not result, as the proponents of regulation and abolition led us at first to believe, because all vaping technologies are medically and scientifically unsound.
Vaping is 95 percent safer than smoking, according to some estimates. Unlike inhaling cigarette smoke, vaping is not carcinogenetic and not, as some have claimed, a proven gateway to teen smoking. Yet it’s under attack as never before.
The hysteria over what’s been called “vaping-related lung illness” has generated enormous pressure on politicians from President Donald Trump on down to do something. That’s understandable but not necessarily right. The attack on the science showing that vaping generally leads to reductions in cigarette smoking and that favored vaping is very much a part of helping people quit is leading to a situation where even more people may die.
For more than a few years, the nascent vaping industry has tried to work with the government to set rules everyone can live with. They’re on board with an under-21 vaping ban, and the biggest player in the marketplace, Juul, has voluntarily agreed to withdraw its few flavored formulas from the U.S. market. No more mint, no more crème, no more cucumber, no more fruit and no more mango — even though studies have shown cigarette smokers find it easier to refrain from smoking if the vaping options available to them are flavored.
An individual earning near the national median at $50,000 a year would pay more than $17,450 more per year in taxes to fund Democrats’ Medicare for All proposal. That’s not even half of it.
Democratic candidates for president continue to evade questions on how they will pay for their massive, $32 trillion single-payer health care scheme. But on Monday, the Committee for a Responsible Federal Budget (CRFB) released a 10-page paperproviding a preliminary analysis of possible ways to fund the left’s socialized medicine experiment.
Worth noting about the organization that published this document: It maintains a decidedly centrist platform. While perhaps not liberal in its views, it also does not embrace conservative policies. For instance, its president, Maya MacGuineas, recently wrote a blog post opposing the 2017 Tax Cuts and Jobs Act, stating that the bill’s “shortcomings outweigh the benefits,” because it will increase federal deficits and debt.
That centrist position makes CRFB’s analysis of single payer all the more devastating, because one cannot write it off as coming from a right-wing group. And its analysis is devastating, carrying it three main messages, as follows.
Consider some of the options to pay for single payer CRFB examines, along with how they might affect average families.
A 32 percent payroll tax increase. No, that’s not a typo. Right now, employers and employees pay a combined 15.3 percent payroll tax to fund Social Security and Medicare. (While employers technically pay half of this 15.3 percent, most economists conclude the entire amount ultimately comes out of workers’ paychecks, in the form of lower wages.) This change would more than triple current payroll tax rates.
Real-Life Cost: An individual earning $50,000 in wages would pay $8,000 more per year ($50,000 times 16 percent), and so would that individual’s employer.
A 25 percent income surtax. This change would apply to all income above the standard deduction, currently $12,200 for individuals and $24,400 for families.
Real-Life Cost: An individual with $50,000 in income would pay $9,450 in higher taxes ($50,000 minus $12,200, times 25 percent).
A 42 percent Value Added Tax (VAT). This change would enact on the federal level the type of sales/consumption tax that many European countries use to support their social programs. Some proposals have called for rebates to some or all households, to reflect the fact that sales taxes raise the cost of living, particularly for poorer families. However, using some of the proceeds of the VAT to provide rebates would likely require an even higher tax rate than the 42 percent CRFB estimates in its report.
Real-Life Cost: According to CRFB, “the first-order effect of this VAT would be to increase the prices of most goods and services by 42 percent.”
Mandatory Public Premiums. This proposal would require all Americans to pay a tax in the form of a “premium” to finance single payer. As it stands now, Americans with employer-sponsored insurance pay an average of $6,015 in premiums for family coverage. (Employers pay an additional $14,561 in premium contributions; most economists argue these funds ultimately come from employees, in the form of lower wages—but workers do not explicitly pay these funds out-of-pocket.)
Real-Life Cost: According to CRFB, “premiums would need to average about $7,500 per capita or $20,000 per household” to fund single payer. Exempting individuals currently on federal health programs (e.g., Medicare and Medicaid) would prevent seniors and the poor from getting hit with these costs, but “would increase the premiums [for everyone else] by over 60 percent to more than $12,000 per individual.”
Reduce non-health federal spending by 80 percent. After re-purposing existing federal health spending (e.g., Medicare, Medicaid), paying for single payer would require reducing everything else from the federal budget—defense, transportation, education, and more—by 80 percent.
Real-Life Cost: “An 80 percent cut to Social Security would mean reducing the average new benefit from about $18,000 per year to $3,600 per year.”
The report includes other options, including an increase in federal debt to 205 percent of gross domestic product—nearly double its historic record—and a more-than-doubling of individual and corporate income tax rates. The impact of the last is obvious: Take what you paid to the IRS on April 15, or in your regular paycheck, and double it.
In theory, lawmakers could use a combination of these approaches to fund a single-payer health care system, which might blunt their impact somewhat. But the massive amounts of revenue needed gives one the sense that doing so would amount to little more than rearranging deck chairs on a sinking fiscal ship.
CRFB reinforced their prior work indicating that taxes on “the rich” could at best fund about one-third of the cost of single payer. Their proposals include $2 trillion in revenue from raising tax rates on the affluent, another $2 trillion from phasing out tax incentives for the wealthy, another $2 trillion from doubling corporate income taxes, $3 trillion from wealth taxes, and $1 trillion from taxes on financial transactions and institutions.
Several of the proposals CRFB analyzed would raise tax rates on the wealthiest households above 60 percent. At these rates, economists suggest that individuals would reduce their income and cut back on work, because they do not see the point in generating additional income if government will take 70 (or 80, or 90) cents on every additional dollar earned. While taxing “the rich” might sound publicly appealing, at a certain point it becomes a self-defeating proposition—and several proposals CRFB vetted would meet, or exceed, that point.
The report notes that “most of the [funding] options we present would shrink the economy compared to the current system.” For instance, CRFB quantifies the impact of funding single payer via a payroll tax increase as “the equivalent of a $3,200 reduction in per-person income and would result in a 6.5 percent reduction in hours worked—a 9 million person reduction in full-time equivalent workers in 2030.”
By contrast, deficit financing a single-payer system would minimize its drag on jobs, but “be far more damaging to the economy.” The increase in federal debt “would shrink the size of the economy by roughly 5 percent in 2030—the equivalent of a $4,500 reduction in per person income—and far more in the following years.”
Moreover, these estimates assume a great amount of interest by foreign buyers in continuing to purchase American debt. If the U.S. Treasury cannot find buyers for its bonds, a potential debt crisis could cause the economic damage from single payer to skyrocket.
To say single payer would cause widespread economic disruption would put it mildly. Hopefully, the CRFB report, and others like it, will inspire the American people to reject the progressive left’s march towards socialism.
One of the problems in health care today is that it turns Oscar Wilde’s quip on its head: In the United States, everyone knows the value of health care, but nobody knows the price of anything (because most spending is covered by insurance or by federal programs such as Medicare).
Pricing information is crucial in any system, because when people know what price they’re paying for a good or service, they can make informed decisions. Also, prices tend to come down over time as people demand better service at lower prices.
However, unlike Walmart or Amazon.com, the federal government isn’t especially good at negotiating lower prices. And now, crony health care interests are fighting to eliminate one of Medicare’s few pricing successes.
The issue involves prescription medicines. Since Medicare Part D was put into place to cover prescription drugs, generic and biosimilar medicines have usually been added to the program as soon as the FDA approved them. That’s given seniors access to safe, effective drugs at a much lower cost. In 2018, for example, generic drugs saved consumers almost $300 billion, with $90 billion of that going to Medicare recipients.
Sadly, though, they could have saved much more. In 2016, the Obama administration changed Medicare policy so that many generics would be priced in the same band as name brand drugs. That’s increased prices for seniors by more than $6 billion.
A good chunk of that money flowed to Pharmacy Benefit Managers (PBMs), which negotiate to get the generic meds priced in a higher band, then pocket “rebates” (kickbacks) from the big drug companies that make name brand drugs. Consumers, meanwhile, miss out on potential savings.
Under the Trump administration, the Center for Medicare & Medicaid Services (CMS) is finally taking steps to roll back the price increases. Next year, it wants to stop Medicare Part D plans from moving generic drugs into branded drug tiers. Instead, it plans to create a new tier reserved just for generics and biosimilars.
Many lawmakers support this sensible policy. “I am pleased to find that CMS is considering an ‘alternative’ policy,” Sen. Bill Cassidy of Louisiana wrote to HHS Secretary Alex Azar. “I applaud CMS for considering these cost-effective policies and urge the Agency to make them final for CY2020.”
Cassidy is a doctor and a leader in the fight for a more conservative approach to health care. He also joined fellow Republican Senators Steve Daines and James Lankford and Democrats Sherrod Brown and Robert Menendez in sponsoring an amendment to The Prescription Drug Pricing Reduction Act of 2019 that would have “ensured lower-cost generic drugs are placed on generic tiers and higher-cost brands stay on brand tiers.” They dropped that amendment for internal reasons, because Finance Committee Chairman Charles Grassley told them he’ll make certain the language makes it into the final bill.
Many other lawmakers are also pushing for the reform. “We encourage CMS to move forward with this policy effective CY2020 to lower out-of-pocket costs for millions of Americans, ensuring that they receive the full value of generic and biosimilar competition,” a bipartisan group of House lawmakers wrote to Azar. “Price competition is vital in the Part D program and beneficiaries deserve a choice at the pharmacy counter when possible.”
Seniors can thank these lawmakers, and should keep a sharp eye on Sen. Grassley. He has a chance to move forward in a bipartisan fashion with a plan that would save Medicare recipients money. That ought to be an easy sell in these divided times.
Conservatives are wary about expanding Medicare, of course. But we’re eager to use pricing power to improve the state of American health care. Let’s not allow PBMs to block this important step toward systemic reform.
Atop the list of what America’s senior adults want are the preservation of their independence and a secure retirement. Admirably they don’t want to end up being a burden anyone, not their spouse, not their children, and not the rest of us. The way the system is rigged, however, almost guarantees they will
Medicare-for-All, which most of the Democrats running for president have endorsed, will only lead to increased dependency. It’s a typical one-size-fits-all proposal that sounds good from the stump and may look good on paper. The numbers though, just don’t work.
The way forward is to expand choice and to allow seniors to take advantage of competition in the health care marketplace to bring prices down. Some already have supplemental insurance that helps fill the financial gap between what they need and what Medicare will pay for but it’s not enough. Some people need more than one walker in order to stay in their homes.
This is where creativity is needed. The green-eye shade types who approve Medicare expenditures spend lots of time thinking about what things cost. Considering how many taxpayer dollars are involved in later-in-life health care, that’s not such a bad thing but it doesn’t always take into consideration what people need.
That forces seniors to make hard choices that can threaten their independence. They need to have more options as they would under a proposal by Dr. Ami Bera, D-Calif., and Jason Smith, R-Mo., that would let them use pre-tax dollars stored up in health savings accounts to fill the gaps between items covered under Medicare and what they are expected to pay for out of pocket.
“Having a Health Savings Account is a powerful resource that reimburses everything from doctor and dentist visits to prescription drugs, first aid supplies, and eyeglasses. Health Savings Accounts also incentivize saving for health-care expenses by providing critical tax benefits, just as we do for saving for retirement or college,” says Kevin McKechnie, the executive director of the American Bankers Association’s Health Savings Accounts Council.
Money put away in an HSA can stay there for decades. Under current law, there’s no “Use it or lose it” provision. That means younger workers can start saving for retirement health care upon entering the workforce and, through the magic of compound interest, build up a nest egg that’s there for them anytime they need it.
That means, if they’re lucky enough to remain relatively healthy and can be disciplined financially, it can be there for them in their retirement years which, it has suddenly become clear to me, come around a lot faster than it seems they will when you’re just starting out.
The tax benefits associated with HSA’s, McKechnie wrote in a recent op-ed, “have become even more important as deductibles and other health-care costs continue to skyrocket.” Struggling families, especially those that include senior adults facing the challenges associated with aging, are finding it harder and harder to plan for they can’t see coming. Expanding the range of services that can be paid for out of health savings accounts give them an additional hedge against the unexpected.
A recent Luntz Global poll found 46 percent support for the Bera-Smith plan and the idea of using HSA funds to fill the Medigap. Expanding the list of approved items upon which HSA dollars can be spent without tax penalties is low hanging fruit as far as health care reform goes. That’s probably why the idea has bipartisan support.
The challenges presented by an aging America in which people living longer and healthier must deal with diseases that can lead more quickly to economic ruin should give us all pause. New thinking is needed, not just where treatments are concerned but in how we make it possible for people to pay for it. We could as a country decide to turn the whole business over to the government but that inevitable means care will be rationed, fewer options will be available, and decisions regarding life and death matters will almost inevitably be taken out of our hands by the bureaucracy.
No one wants to live like that, and no one wants a loved one to die like that. The Bera-Smith Health Savings for Seniors Act will cover the gaps and help bring the cost of health care under control. At least 82 percent of those who answered the Luntz Global survey think it will. It’s time to give it a chance.
The best way to ensure better medical care for all is to reject Medicare for All.
Health care ranked as most important issue, save for “the ability to beat Donald Trump,” for Democratic voters in a FiveThirtyEight/Ipsos poll taken before and after last week’s presidential debate.
The debate revealed fissures among the party’s presidential aspirants on health care.
Bernie Sanders pronounced his desire that “every American has health care as a human right and not a privilege.” But under the senator’s “Medicare for All” scheme, private health insurance becomes illegal.
Would any American regard it as in keeping with the First Amendment if the government limited all 330 million of us to one church or one newspaper? The senator’s conception of rights, several opponents seemed to say, is wrong.
“While Bernie wrote the bill, I read the bill,” Amy Klobuchar quipped. She objected to Medicare for All forcing about half of Americans off their existing private insurance. “I don’t think that’s a bold idea,” the Minnesotan noted. “I think that’s a bad idea.”
Mayor Pete Buttigieg said he supported “Medicare for all who want it.” He objected to the one-size-fits-all quality of Sanders’ plan. “I trust the American people to make the right choice for them,” he told Sanders. “Why don’t you?”
Joe Biden balked at the price, estimated to eclipse what the federal government currently takes in in revenues. The former vice president pointed out, “Nobody’s yet said how much it’s going to cost the taxpayer.”
Sanders and Sen. Elizabeth Warren, who supports his plan, pushed back. Vermont’s junior senator railed against “the drug companies and the insurance companies.” Warren explained, “I’ve never met a person who likes their insurance company.”
Given that insurance companies issue bills to consumers, this necessarily makes them unpopular. But the majority of costs come from hospitals (33 percent) and physician and clinical services (20 percent), according to the Center for Medicare and Medicaid Services (CMS). We want to kill the messenger. Those primarily responsible for the message — $25 for two aspirin pills, $120 for a cloth sling, $57,000 for a knee replacement — somehow not only escape our wrath but also win our admiration.
Hospitals gouging patients occurs most glaringly in places where hospitals operate as a monopoly and in emergency situations. The common denominator in both circumstances involves the inability to compare and shop.
In a paper published earlier this year in the Quarterly Journal of Economics, academics at Yale, Penn, MIT, and Carnegie Mellon note hospital price increases for the privately insured when competition decreases. “Prices at monopoly hospitals are 12% higher than those in markets with four or more rivals,” their abstract reads.
Monopoly hospitals also have contracts that load more risk on insurers (e.g., they have more cases with prices set as a share of their charges). In concentrated insurer markets the opposite occurs — hospitals have lower prices and bear more financial risk. Examining the 366 mergers and acquisitions that occurred between 2007 and 2011, we find that prices increased by over 6% when the merging hospitals were geographically close (e.g., 5 miles or less apart), but not when the hospitals were geographically distant (e.g., over 25 miles apart).
In the emergency room, when circumstances necessarily kill the ability to shop, spending per patient more than doubled from 2008 to 2017, according to research compiled by Kevin Kennedy and John Hargraves for the Health Care Cost Institute.
Reducing health-care costs requires more competition, not a monopoly. Change soon comes, and not necessarily legislative change of the Medicare for All variety. Data stored in the cloud and available via an app may make medical costs and outcomes transparent, which should reduce cost. Medicare for All will retard this process since the whole health-care industry will lobby against the smartphone apps, and the consolidation of the entire industry necessarily leads to less competition.
Beyond transparency enabling health-care consumers to shop, the industry appears ripe for new players. Amazon, JPMorgan Chase, and Berkshire Hathaway, for example, entered the field last year. If they do not ultimately seek to dethrone the status quo, why did UnitedHealth’s Optum sue to stop a former employee from working at the trio’s health-care startup? A $3.6 trillion industry remains too big a cash cow for the giants of tech and finance to resist a milking.
Competition is coming. Price transparency is coming. If Medicare for All is coming, then neither is coming.
Even the ‘moderate’ proposals would sabotage private coverage, driving everyone into a government-run system. That’s probably why Democrats don’t really answer questions about their health proposals.
For more than two hours Thursday night in Houston, 10 presidential candidates responded to questions in the latest Democratic debate. On health care, however, most of those responses didn’t include actual answers.
As in the past several contests, health care led off the debate discussion, and took a familiar theme: former vice president Joe Biden attacked his more liberal opponents for proposing costly policies, and they took turns bashing insurance companies to avoid explaining the details behind their proposals. Among the topics discussed during the health care portion of the debate are the following.
Most notably, Massachusetts Sen. Elizabeth Warren again declined to admit whether individuals will lose their current insurance, or whether the middle class will pay more in taxes, under a single-payer health care system. By contrast, Vermont Sen. Bernie Sanders claimed that while all (or most) Americans will pay higher taxes to fund his single-payer system, middle class families will come out ahead due to his plan’s elimination of deductibles and co-payments.
The problems, as Biden and other Democratic critics pointed out: First, it’s virtually impossible to pay for a single-payer health care system costing $30-plus trillion without raising taxes on the middle class. Second, even though Sanders has proposed some tax increases on middle class Americans, he hasn’t proposed nearly enough to pay for the full cost of his plan.
Third, a 2016 analysis by a former Clinton administration official found that, if Sanders did use tax increases to pay for his entire plan, 71 percent of households would become worse off under his plan compared to the status quo. All of this might explain why Sanders has yet to ask the Congressional Budget Office for a score of his single-payer legislation: He knows the truth about the cost of his bill—but doesn’t want the public to find out.
Believe it or not, Biden once again repeated the mantra that got his former boss Barack Obama in trouble, claiming that if people liked their current insurance, they could keep it under his plan. In reality, however, Biden’s plan would likely lead millions to lose their current coverage; one 2009 estimate concluded that a proposal similar to Biden’s would see a reduction in private coverage of 119.1 million Americans.
Minnesota Sen. Amy Klobuchar echoed Biden’s attack, saying that while Sanders wrote his single-payer bill, she had read it—and pointing out that page 8 of the legislation would ban private health coverage. (I also read Sanders’ bill—and the opening pages of my new book contain a handy reading guide to the legislation.)
For his part, Sanders and Warren claimed that while private insurance would go away under a single-payer plan, people would still have the right to retain their current doctors and medical providers. Unfortunately, however, they can no more promise that than Biden can promise people can keep their insurance. Doctors would have many reasons to drop out of a government-run health plan, or leave medicine altogether, including more work, less pay, and more burdensome government regulations.
While attacking Sanders’ plan as costly and unrealistic, Biden also threw shade in Warren’s direction. Alluding to the fact that the Massachusetts senator has yet to come up with a health plan of her own, Biden noted that “I know that the senator says she’s for Bernie. Well, I’m for Barack.”
Biden’s big problem: He wasn’t for Obamacare—at least not for paying for it. As I have previously noted, Biden and his wife Jill specifically structured their business dealings to avoid paying nearly $500,000 in self-employment taxes—taxes that fund both Obamacare and Medicare.
Tax experts have called Biden’s avoidance scheme “pretty aggressive” and legally questionable, yet neither Democrats nor Thursday’s debate moderators seem interested in pursuing the former vice president’s clear double hypocrisy about his support for Obama’s health care law.
I’ll give the last word to my former boss, who summed up the “contrasts” among Democrats on health care:
Dem debate on health care:@berniesanders: If you like your health plan, too bad, we are going to take it away now.
“Moderate” Dem: If you like your health plan, don’t worry, we will gradually take it away.#DemDebate #DemocraticDebate2078:47 PM – Sep 12, 2019Twitter Ads info and privacy104 people are talking about this
As I have previously noted, even the “moderate” proposals would ultimately sabotage private coverage, driving everyone into a government-run system. And the many unanswered questions that Democratic candidates refuse to answer about that government-run health system provide reason enough for the American people to reject all the proposals on offer.
Only if we developed a fondness for long waiting lines and ever more insurance mandates.
he United States has a complex health-care delivery system composed of private and government-funded insurance plans. Half of all Americans receive their health insurance from their employer or their spouse’s employer. Over 40 percent of Americans receive their health insurance from the government. The remainder are either uninsured or obtain health insurance through the private individual market. The current political debate concerns how large a role the government should play in our health-care delivery system.
The United States spends far more money per person on health care than other industrialized countries. Last year, overall medical spending in the U.S. totaled $3.5 trillion or 18 percent of the national gross domestic product.
Because other countries spend less on health care, they are often used as models for the U.S. Looking to other countries to solve our health care delivery system problems, however, may not be reasonable. Other countries are smaller than the U.S. and have more homogenous populations. What the people of one country favor may not be applicable or acceptable to people living in a different society.
According to a Forbes survey, the U.S. accounts for 38 percent of life-saving and life-extending medical innovations, compared to an average of 15 percent in other countries. The U.S. also leads the world in the research and development of pharmaceuticals.
In all other industrialized countries, the demand for health care is much greater than the money budgeted for it. The results of this supply/demand mismatch are chronic shortages followed by strict rationing of health care. The rationing can take many forms — from long waits, to denying the elderly access to certain procedures, to allowing individuals with political influence to receive priority attention from providers.
Canada has a truly single-payer, nationalized system that is totally funded by taxpayers. In 2018, wait times for specialty care averaged 20 weeks. In practice, Canada has a two-tiered system in the sense that officials allow their citizens to travel to the U.S. for privately funded health care.
Great Britain established a comprehensive government health-care system in 1948 that gives every citizen cradle-to-grave coverage. About 10 percent of the population has private insurance, and many physicians combine government entitlement work with private practice. Over the past year, 250,000 citizens have waited more than six months for planned treatments within the National Health Service, while 36,000 people have waited nine months or more.
Switzerland has a comparatively large private health-care sector, and patients are responsible for 30 percent of their own health-care costs. Consequently, a certain degree of health-care consumerism exists in Switzerland, and the country has been fairly successful in holding down costs. Unfortunately, as officials increase the number of benefit mandates required in insurance plans, health-care costs are rising.
Singapore has a multi-tiered system with different levels of care depending on the patient’s ability and willingness to pay more. This is similar to the system in the U.S. before the passage of Medicare and Medicaid: private hospitals and doctors treated paying patients and charity hospitals and residents-in-training cared for low-income patients.
Is there some combination of measures from other countries that the U.S. can use in reforming our health-care delivery system? Although the overall systems vary, the common factor for all other countries is government-mandated health insurance. Even those countries that have a component of “private” health care continue to mandate that every citizen have government-approved health insurance.
While universal health insurance coverage is a worthy goal, the critical point is using the best mechanism to allow the greatest number of Americans access to health care. Simply having health insurance in no way guarantees timely access to health care. The American experience with the Veterans Administration hospital system, a comprehensive, government-controlled, single-payer health-care program, reveals unacceptable wait times and huge inefficiencies.
The United States distinguishes itself from other countries by a broader use of free markets. Just like all other economic activities, the free market offers the best solution to provide the greatest access to health care and to control costs.
Instead of looking to other countries, health-care reform in the U.S. should allow Americans to freely make their own health-care decisions and use their own health-care dollars. This would give Americans the best chance to use their right to access health care. Eliminating third-party payers, greater use of health savings accounts, price transparency, and health insurance reform would put patients, rather than the government, in charge of their own health care.
We have been witnessing unprecedented innovations in medical treatments. In the coming years new drug therapies promise to provide solutions for some of the most pressing diseases — diabetes, cancer, heart disease, strokes, Alzheimer’s, retinal diseases — to name only a few. But if People for the “Ethical” Treatment of Animals (PETA) gets their way, most of the research that feeds the amazing future cures that we read about will be shut down or severely curtailed.
For the past few years PETA has undertaken a pressure campaign designed to intimidate airlines from transporting medical research animals. Even though it is illegal for the airlines to refuse to perform service, the campaign is proving successful in certain cases and a widespread adoption of this policy would likely stymie medical innovation.
PETA opposes all forms of animal testing despite the fact that the National Institutes of Health views such research as required by ethics and essential to finding cures. Scientists and researchers do as much research as possible with computer modeling and peer reviewed science, but at some point they must test the most promising medicines on living organisms. For example, pigs were used to develop both the ability to transplant a heart and the drugs that stop the body from rejecting the new heart. It was done ethically, with rigorous standards and oversight, and with anesthetics so as to eliminate pain for the animals involved. But PETA ignores all of this and labels these critical experiments the same as torture.
There are places were there is no animal testing. For example, in China, they test procedures and new products on humans who are prisoners of the state. So effectively, humans become the lab rats. That isn’t an improvement in ethics.
PETA’s real agenda is profoundly anti-human. PETA president and co-founder, Ingrid Newkirk admitted as much stating that: “Even if animal research resulted in a cure for AIDS [or cancer or other horrible diseases], we’d be against it.”
When Hamas terrorists used flaming falcons and exploding donkeys to kill Israeli civilians, PETA under political pressure denounced Hamas — but only for harming and killing the animals — not for endangering or harming the school children in the way of these living weapons. This lack of concern for people is truly disturbing.
PETA’s supporters have filed comments with the Department of Transportation hoping to shut down any medical research with animals. One comment simply said: “Stop experimenting on animals. Experiment on your children and mothers instead.” Then with absolutely no sense of irony, this commenter also accused those who reject the idea of using children and mothers in medical research of being “a bunch of barbarians.” Let that sink in.
But PETA’s track record on animals isn’t so great either. For example, in Virginia, PETA activists were charged for criminal animal abuse. Then there is the PETA animal shelter kill rate from 2007-2017 — a full decade — which averaged 95.3 percent. Simply stated animals that were intended for adoptions were abused and then killed in 95% of the cases by an organization supposedly promoting the ethical treatment of animals. A PETA spokesperson quipped, “there are fates worse than euthanasia.”
The ends to which this organization will go to supposedly defend the interests of animals knows no bounds. PETA led the move to change the packaging of animal crackers that used to show cartoon circus animals in carton railcar cages. Thanks to PETA, the carton animals now roam free on the African Savannah. I’m sure we can all feel better than cartoon lions and elephants now roam a cartoon grassland.
Sadly, as silly as that effort was, far more serious is the mounting public relations campaign PETA is waging to pressure airlines to refuse to transport animals (below deck in climate controlled areas of the plane) that will be used in medical research. To date, United Airlines has caved to PETA’s pressure campaign. What’s so strange is that United’s CEO, Carlos Munoz, is alive today because he had a heart transplant that was made possible because of medical animal research.
Here’s some context — airlines often allow passengers to bring comfort pets to travel by their side — dogs, cats, rabbits, pigs, peacocks, ducks, roosters, turkeys, and even kangaroos and miniature horses. This inconveniences other passengers and in some cases causes severe health problems for other passengers. On the other hand airlines are caving to PETA’s pressure campaign and refusing to transport animals used in ethical, humane & government mandated testing of new cures. These animals will not inconvenience or endanger any passengers. But this is the weird world you get when the lunatics run the asylum.
Airlines win kudos for donating flights to children in need of cancer treatment at specialized medical centers far from their home. At the same time, some airlines refuse to transport research animals and make it more difficult to develop the very cures and medicines needed to cure these sick children.
It is illegal for the airlines to discriminate against transportation of animals for research purposes. Public carriers have long been prohibited from discriminating when it comes to transportation. Non-discrimination laws for airlines do not simply prevent racial discrimination. The law also prevents an airline from transporting animals for zoos, or vacationing passengers, or as comfort animals, and then refusing to transport similar animals to be used in lawful and ethical medical research.
The law is clear — if the airline is willing to ship one woman’s dog or cat, it must also ship other similar animals being transported even if for different purposes — including medical research. Airlines have no real basis for objecting because they are paid to transport them, and these animals actually have no impact on their passengers as they would be shipped below the passenger compartment.
But because they are fearful of the bad press of PETA’s false claims of animal torture, Airlines give in. We all love pets and animals. But who wants to be slimmed by PETA as the equivalent of a war criminal for trying develop heart translate procedures and medicines or for curing cancer?
We need the Department of Transportation to enforce the law. We wouldn’t tolerate an airline discriminating against a racial or ethnic group and we shouldn’t tolerate this form of discrimination either. The lives of countless millions depend on the cures and medicines that are being developed in careful, thoughtful and ethical ways.
When the federal government sets out to solve a problem, it often begins by making the problem larger.
For example, lawmakers may want to reduce pollution. Or cut down on the use of fossil fuels. So they pass a “Clean Air Act,” or mandate the use of renewable fuels. But now they need inspectors. And lawyers to file (and respond to) lawsuits. The big problem gets bigger as it gets bogged down in bureaucracy, and a solution may seem ever further away.
As a Microsoft blogger once joked, “if the solution begins with ‘First, install…’ you’ve pretty much lost out of the gate. Solving a five-minute problem by taking a half-hour to download and install a program is a net loss.” The same can be said about Washington. If the answer is “First, pass legislation…” then your problem probably isn’t going to get solved, especially in today’s environment of divided government.
But bad things keep happening to good people. For example, anyone with insurance can be sent to a care center that’s not covered by their network and end up with a big bill. That isn’t fair. So how can policymakers bring down their health care costs?
As always, Washington’s response begins with a big bill, the “Lower Health Care Costs Act of 2019,” penned by Tennessee Republican Lamar Alexander. One goal of the bill is to set prices in cases of surprise billing, so insured patients that are taken to out-of-network facilities without their knowledge aren’t hit with huge bills. The bill plans do to so by capping provider costs at the median in-network rate.
If the LHCC gets the prices wrong -and if the history of price controls provides any indication, it will – it could lead to yet another Obamacare-esque death spiral, where premiums rise, hospitals lose money, and doctors stop seeing patients.
The legislation’s big-government, top-down solutions won’t amount to a very effective way to push back against high prices. The faster and more effective way is to encourage competition. One way to do that is by allowing market negotiations to proceed.
The STOP Surprise Medical Bills Act, introduced by Sen. Bill Cassidy, M.D. (R-La.) and Sen. Tom Carper (D-Del.), would do just that. When cases of surprise medical bills pop up, The STOP Surprise Medical Bills Act would allow all players in the healthcare industry to submit proposals to an arbiter, who would ensure that the best offer for consumers wins the day. This process will create far more informed, data-driven decisions than the LHCC’s blanket price controls ever could.
We also need more doctors, which would increase competition among physicians and help force prices down. Instead, we’re chasing doctors out of the profession. “The United States could see a shortage of up to 120,000 physicians by 2030,” warns the Association of American Medical Colleges.
Well, federal policies can make it more difficult than ever to practice medicine. For example, it can cost more to treat Medicaid patients than the federal government is willing to pay. That squeeze is an example of the wrong way to approach price cuts, yet it’s the one that Washington usually turns to. It’s at least partially responsible for the decline in the number of doctors.
Big medical bills are a big problem. Together we can solve that problem. But first, let’s prevent Washington from making it even bigger by imposing the LHCC Act.
By Red State•
It’s bad enough when politicians rob from future generations by piling on debt to the nation’s ruinous finances. Now the Administration and Senate Republicans are considering paying for Nancy Pelosi’s exorbitant spending demands by decimating medical innovation.
But don’t worry, kids: sure it’ll kill future life-saving medicines from ever coming to market, but when you’re done paying for this Pelosi-scale largess, I’m not sure you’ll be able to afford anything nice, anyway.
The deal reportedly under discussion in the Senate would be to meet almost all of Pelosi’s spending demands — did I mention that Republicans control the Senate and President Trump is our chief executive? — and “paying” for it in part by installing crudely designed price controls on the drug industry.
This bright idea is the brain child of Sen. Ron Wyden (D-OR), the chairman, er, ranking member, of the Senate Finance Committee. (Sorry – it’s easy to get confused about who is running things over there).
The headline at Politico tells you everything you need to know: “Senate Republicans pray Trump will take budget deal.”
Imagine how that’s going to go:
“So you’re meeting Pelosi’s spending levels?”
“Yes, sir, Mr. President.”
“And raising the debt ceiling?”
“How the hell are you going to pay for it?”
“Price controls, sir.”
It’s a complete disgrace, and I expect Trump will not take kindly to an outcome where he gets taken for a ride by Nancy Pelosi.
The price controls under discussion are a “Squad”-caliber idea, the “Squad” being the quartet of Socialist Democrats led by Alexandria Ocasio-Cortez who spent last week attacking Pelosi as a racist for not being left-wing enough (you can’t make this up!).
I describe it that way because the proposal is the same combination of Che Guevera-t-shirt-wearing ideological zealotry and breathtaking economic illiteracy responsible for such gems as AOC’s comically melodramatic pronouncement that “the world is going to end in 12 years” because of global warming.
Price controls are already the economic equivalent of a child demanding a pony: they demand an outcome without any regard or awareness of the reality of making it so. We want lower prices, so we’ll order them lower! Except, the cost of production remained just the same, or even increased once the people putting nation-state-level amounts of capital on the line just noticed the infantile children bickering in Congress are about to make a big mess.
The cost of producing one new drug is typically $2.5 billion. Private companies have to pay that up front, without knowing if the effort will succeed or fail, or in this case whether Wyden and Pelosi will decide they need some of that moolah to pay for women’s studies departments, free abortions and sex changes, and only Heaven knows what other insanities they can dream up.
But, you know, some children at least know something about ponies. Some demand a Shetland, for example. The Wyden child doesn’t even know what a pony is, he’s just throwing a tantrum. That’s my best attempt at explaining how stupidly designed these particular price controls are.
First, the proposal punishes price increases of individual drugs compared to inflation. Not only does this ignore any particular circumstances (sudden spike in supply cost for a particular compound, for example), it creates a giant incentive to pad price increases across the entire product line, untethering the price of any individual drug from actual production costs.
Second, the vehicle for delivering these price controls is the Medicare Part D, otherwise known as the one part of the entire federal health care system that shows any sanity and cost-effectiveness — thanks to its use of market principles.
Part D is the only large government program in the history of humanity to come in 40% under budget, which is practically on par with feeding the crowd of 5000 from a basket when you think of the endless list of failed health care “reforms” that cost an eye-watering amount above their price tag.
Why did Part D work? Because it managed to install some semblance of a market, which consumer choice, and real competition, in the form of the plans that compete for patients. Exactly the opposite of the price controls we may be on the verge of adopting to “pay for” Pelosi’s world domination tour — sorry, the obscene spending she demanded and the Senate Republicans appear all too happy to accept.
It’s shameful. Something deep inside the chests of Senate Republicans should cause them to reject a bad Pelosi proposal — simply as a matter of self-respect! But if you believe that most politicians have anything more than trace amounts of self-respect, boy have I got some wonderful price controls to sell you!
Perhaps it’s time for Bernie Sanders to put his money where his mouth is and pay his staffers a “living wage”—and the overtime they should be entitled to.
For all is rhetoric, it may turn out that socialist Sen. Bernie Sanders is just another hypocritical politician who takes money from big corporations, invests in Wall Street and, reportedly, pays his workers “poverty wages” (and NO overtime)—despite the fact that they’re unionized.
Back in March, to show his “pro-union” bonafides, Bernie Sanders made headlines when he encouraged his staffers to unionize with the United Food & Commercial Workers, turning his campaign into the first-ever unionized presidential campaign.
However, as often happens when activists who campaign to dictate standards upon others actually have to live under those standards, things do not always go as planned.
On Thursday, the same day that the House of Representatives passed a bill to raise the federal minimum wage to $15 an hour—which Sanders has long advocated for—the Washington Post ran an article that shed some light on a wage dispute that is currently going on within his campaign.
Apparently, Sanders’ campaign workers are lashing out at campaign management regarding the low wages that they are receiving.
“I am struggling financially to do my job, and in my state, we’ve already had 4 people quit in the past 4 weeks because of financial struggles,” one field organizer reportedly wrote on a message board to Sanders’ campaign manager Faiz Shakir.
Another employee wrote his co-workers “shouldn’t have to get payday loans to sustain themselves.”
Then, there was this interesting statement:
The draft letter estimated that field organizers were working 60 hours per week at minimum, dropping their average hourly pay to less than $13. [Emphasis added.]
As field organizers are paid an annual salary of $36,000 under their new union contract, things would be fine—if they are only working 40 hours per week.
However, it appears they are not.
If they are truly working 60 hours per week (or 3,000 hours per year), on a salary of $36,000, they are only making $12 per hour, instead of the $17.30 they should be making on a standard 40-hour week, 2,080-hours per work year.
Obviously, $12 per hour is far less than the $15 Bernie Sanders claims to support.
However, it’s worse than that.
Based on the article, it also appears that Sanders is not paying overtime.
Under the Fair Labor Standards Act (FLSA) of 1938, employees who are not exempted from the law are entitled to time and one half pay for every hour worked after 40 hours in a given workweek.[Some states (and, more importantly, some union contracts) actually mandate time and one half after eight hours.]
If the Sanders campaign workers are not exempt from the FLSA and are entitled to overtime, they should be making nearly $26 per hour for every hour worked over 40.
Following the 2016 election, the DNC was sued by former field organizers who alleged that the “the state party defendants conspired with one another and with Defendant DNC to unlawfully designate Plaintiffs, and those similarly situated, as exempt employees under the FLSA and applicable state wage statutes, thereby denying Plaintiffs full and appropriate compensation.”
Unfortunately for the DNC’s field organizers, the suit was dismissed in 2018.
In dismissing the overtime suit, according to this summary, “the Court relied on an often-overlooked defense to the Fair Labor Standard Act (“FLSA”) – namely, that the FLSA only covers employees engaged in interstate commerce as opposed to employees engaged in purely local activities. [Emphasis added.]”
That case involved multiple state parties (as well as the DNC)–and not a singular candidate.
In the case of Bernie Sanders, however, a court could determine his campaign to be a singular employer…and, if so, it is definitelyoperating across state lines (interstate commerce).
It is also possible that the new union contract may aid a court in establishing that employees are not exempted from the FLSA. However, neither the campaign, nor the UFCW has released the contract to the public.
Perhaps it’s time for Bernie Sanders to, quite literally, put his money where his mouth is.
A new proposal under discussion by the Senate Finance Committee is a perfect example of the folly of trying to centrally design the economy — in this case by a ham-handed attempt at price controls.
The proposal, from Sen. Ron Wyden (D-OR) and under consideration by Chairman Chuck Grassley (R-IA), would change the Medicare Part D prescription drug rebate to penalize drugs whose prices rise faster than the rate of inflation.
It’s ironic the proposal targets Part D, one of the few islands of economic sanity to be found in the health care sector, which, beset by rampant government intervention, suffers from a wide variety of perverse unintended consequences.
Part D is one of the few government health care programs to successfully foster price-based productivity increases. In most parts of the economy, over time, prices go down and quality goes up, due to increases in productivity. The underlying mechanism driving this is competition.
One sign of how successful Part D has been in wielding competition is that in its first decade of existence, it cost over 40% less than what the Congressional Budget Office estimated it would, a historical and underappreciated achievement.
Tacking on feel-good, one-off pricing rules like Wyden’s “faster than inflation” penalty could easily disrupt the market-based dynamics that enabled Part D to flourish in the first place.
It’s just silly to think that something as complex, distributed and organic as a worldwide market for pharmaceutical drugs could be controlled by something as ramshackle as a “faster than inflation” rule.
Consider the variety of pricing mechanisms that exist in well-functioning markets. In retail, there are coupons, package deals, membership plans and other discounts. In the stock market, there is the “continuous auction,” providing ongoing price discovery that can react to new information in a matter of seconds.
Amazon’s server rental business offers clients a tremendous range of pricing options, split by eighteen datacenter regions, dozens of server types, and several tiers of availability.
There is a whole world of financing, from store-offered, no interest payment plans to credit cards to mortgages. Stores employ all manor of psychological pricing tricks, such as charging 99 cents instead of $1. One of the more incredible such tricks, which would be hard to believe without the well-established research backing it up, is that prices that contain fewer syllables (when read out loud) are more attractive than those with more syllables. For instance, $28.16 (five syllables) is better than $27.82 (seven syllables).
The incredible diversity in pricing practices stems from the decentralized nature of the market. You could never ask a single committee, or even a large organization, to come up with this level of creativity and variety on its own. It’s only from the organic interaction between millions of businesses and billions of customers, each expertly seeking their own interests, that it can ever arise.
You might compare Wyden’s “faster than inflation” proposal to the fences in Jurassic Park — “life finds a way,” as Dr. Ian Malcolm tells us, foreshadowing the inability of the park to contain the beasts contained within. Except, at least the 40-foot electric fences were a good faith effort. Wyden’s proposal is more like if they attempted to keep the T-Rex at bay with only the thin walls of the bathroom hut the hate-able lawyer ran and hid inside, shortly before becoming a dinosaur’s dinner.
In other word’s this “faster than inflation” rule is a laughable, pitiful attempt at something that isn’t even achievable by the most expert, determined effort — something like, say, the Soviet Union, which tried, and failed, to put price controls into practice at super power scale.
But that’s not to say it can’t do harm. At the very least, it will increase the cost of participating in the market, both in terms of compliance costs, and in the changed incentives and their inevitable unintended consequences. For example, a company that requires more revenue to survive might raise the prices slightly on all its products, instead of steeply on just one. How this all plays out is impossible to predict. What can be said for certain is the market’s “logic” would now be less about providing the most value for customers at the lowest price, and now more about the political ramifications of pricing decisions.
More specifically, as it relates to the Part D drug market in particular, the rule could crowd out existing rebates negotiated by the plans buying the drugs. Many plans have already secured “price protection rebates” which kick in if prices increase more rapidly than some agreed-upon threshold. In other words, the market has already invented, in a much more sophisticated and dynamic way, the “faster than inflation” rule on its own.
The worst case scenario is more dire. Generally speaking, fostering well-functioning markets in the health care sphere is exceedingly difficult, given the immense government intervention at every level. Part D’s success in doing so is nearly unique. Additional rules that make supply and demand less important to how the market functions could result in it ceasing to function as a market entirely. It certainly would not be the first time the government accidentally killed a market.
Wyden’s proposal exemplifies the folly of centrally-designed price controls. It will harm one of the only well-functioning parts of the federal government’s health care policy. For those reasons, Chairman Grassley and Committee Republicans should cast it in the dustbin of bad socialist ideas.
Ezra Klein thinks it’s “ridiculous” to ask Democratic presidential candidates whether they want to abolish private health insurance. It’s supposedly ridiculous because the correct answer isn’t yes or no, but “it depends.”
Several of the Democratic candidates have endorsed Senator Sanders’s Medicare for All bill. Klein takes up the subject:[I]f you assume both the generosity and the financing of Sanders’s plan, there’s really no reason to debate private insurance. If the government will cover everything, with no copays or deductibles or hidden forms of rationing, then there’s no need for private coverage. . . .[Sanders’s bill] doesn’t actually abolish private insurance. It outlaws “health insurance coverage that duplicates the benefits provided under this Act.” If the proposed benefits contracted during the legislative process, it would open more room for private insurers to enter the system. So even Sanders’s answer to this question isn’t truly “yes” or “no.” It depends on what’s covered, which in turn depends on how much Americans are willing to pay in taxes.
Klein then lists questions that he thinks debate moderators should be asking instead: Would your plan include cost sharing at the point of service, how would prices be determined, and so on. They’re not bad questions. But neither is the question about outlawing private insurance. In the first place, whether the Sanders proposal would change in the legislative process is irrelevant to the question of what the candidates are seeking. Their endorsement tells us the answer to that question. It is also hard to picture the Sanders proposal changing so much that anything like the private health-insurance policies that scores of millions of Americans now rely on could survive.
Several candidates — Gillibrand, Warren, Sanders, Harris, and probably a few others I’ve forgotten — have endorsed, of their own free will, making it illegal for Americans to buy the kind of insurance most of them now have. Americans should be informed about what Democratic health programs will look like. They should know as well whether they’ll have a choice about participating.
House Speaker Nancy Pelosi is considering a monumental change to Medicare — and believes that President Donald Trump might support her plan.
Her big idea? Binding arbitration — a method that empowers government-appointed “arbitrators” to dictate the price of new medications and treatments. She hopes it’ll lower drug spending.
That would represent an enormous change from the status quo. Right now, drug makers negotiate directly with private insurers and healthcare providers.
Arbitration is just a fig leaf for government price controls. Arbitrators are supposed to be unbiased. But they’d likely always side with the government officials who appointed them — and set prices well below fair-market value. Like all price controls, arbitration would discourage medical innovation.
Under Medicare, drug coverage is broken into two parts. Medicare Part B covers potent medicines, like chemo- and immunotherapies, that physicians administer in hospitals and doctor’s offices. Medicare Part D covers prescription drugs that patients can pick up at the pharmacy.
For both programs, drug prices are determined through negotiations between drug makers and private payers, like hospitals or insurers.
In a binding arbitration system, if Medicare officials aren’t satisfied with those negotiated prices, they could appoint an arbitrator to do their bidding. Medicare officials would explain to arbitrators why they feel a lower price is justified. Pharmaceutical companies would justify their own suggested price.
Arbitrators would then choose a legally binding price. And their decision wouldn’t be limited to the two proposals on offer.
This type of dispute resolution is also called “baseball arbitration.” Baseball teams are well known for bringing in neutral arbitrators to resolve contract disputes. But Pelosi’s arbitration plan shouldn’t be compared to the big leagues, as the government would run the entire show. Government officials would get to pick the arbitrators — and would almost certainly choose ideologues who agree with them. So the “negotiation” would function identically to price controls.
Price controls always stifle innovation and harm patients in the long run.
Drug development is a risky business. It takes about $2.6 billion and between 10 and 12 years, on average, to create just one new drug. Around 90 percent of medicines never make it past clinical trials.
Investors are willing to take such financial risks on the off chance their drug succeeds and is profitable. Price controls eliminate that potential by making it harder for companies to recoup their R&D expenses. No investor would risk her capital knowing the government could undervalue her discoveries.
Just look at what price controls did to Europe. In the 1970s, European companies made more than half of the world’s new drugs. Then governments across Europe began to implement various price control schemes over the next 10 years. European countries develop less than 33 percent of new drugs today.
The United States, on the other hand, is the global leader in drug development — and has done so for over three decades. Because our healthcare system values drugs fairly, drug innovators are eager to research and develop drugs stateside. In fact, America’s biopharmaceutical industry dedicated close to $90 billion in R&D efforts in 2016.
All that investment has paid off, too. In the United States, researchers are developing roughly 4,000 new medicines targeting a range of diseases — including potential cures to Alzheimer’s, cancer, and diabetes.
If binding arbitration takes off, Americans may never benefit from these potential treatments. Instead, patients would be left at the mercy of diseases for which there are currently no cures.
Binding arbitration doesn’t deserve President Trump’s support — or the support of Democrats. Letting the government set drug prices would hinder future medical advances.